"Work requirements impose an additional, unnecessary barrier to allowing patients access to vital health care services for people who need access and coverage the most."
— Jack Ende, M.D., president, the American College of Physicians

• Budget Office Cuts Cost Estimate of Children's Insurance Associated Press by Alan Fram — Congress's official budget analysts have eased one stumbling block to lawmakers' fight over renewing a program that provides health insurance for nearly 9 million low-income children. The Congressional Budget Office says a Senate bill adding five years of financing to the program would cost $800 million. Previously, the analysts estimated it would cost $8.2 billion. That means lawmakers should find it much easier to agree to a way to pay for extending the program.
  
  

• Parents Agonize Over Their Kids' Health as Funding for Children's Insurance Program Remains in Doubts  Los Angeles Times by Noam Levey — Like roughly 9 million children nationwide, Bobby and Dylan are covered by the Children's Health Insurance Program, or CHIP, a government health plan created in 1997 for kids of working families. What keeps their parents up at night are warnings the program may be suspended because Congress has failed since Sept. 30 to pass a measure to reauthorize it. And although lawmakers passed a stopgap before Christmas, West Virginia is among several states that have warned parents the program could close soon, in its case, at the end of next month. In Washington, the short-term CHIP funding has been largely written off as a footnote in broader political fights consuming the capital. But for the Belts and legions of other working-class parents around the country, the uncertainty has been agonizing.

• Major Shift as Trump Opens Way for Medicaid Work Requirement  Associated Press by Ricardo Alonso-Zaldivar — In a major policy shift that could affect millions of low-income people, the Trump administration said Thursday it is offering a path for states that want to impose work requirements on Medicaid recipients. Seema Verma, head of the Centers for Medicare and Medicaid Services (CMS), said work and community involvement can make a positive difference in people’s lives and in their health. Still, the plan probably will face strong political opposition and even legal challenges over concerns that some low-income beneficiaries will lose coverage. The administration said 10 states have applied for waivers involving work requirements or community involvement. They are: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin. Advocates for low-income people say they expect Kentucky’s waiver to be approved shortly.

• To Get Medicaid in Kentucky, Many Will Have to Work. Advocates for the Poor Say They Will Sue  New York Times by Abby Goodnough — Kentucky will be the first state to require many of its Medicaid recipients to work or face losing their benefits after the Trump administration approved its plan on Friday.  Advocates for the poor threatened lawsuits, while Gov. Matt Bevin, a Republican, celebrated the approval as "the most transformational entitlement reform that has been seen in a quarter of a century." The plan calls for most Medicaid recipients who are not disabled and aged 19 to 64 to work at least 20 hours a week, beginning in July. In addition to paid jobs, they could meet the requirement through volunteer work, job training, searching for a job, taking classes or caring for someone elderly or disabled.
  
  
• CMS Maintains Medicaid Work Requirements Can Withstand Legal Challenges Modern Healthcare by Matthew Weinstock and Virgil Dickson — The CMS is confident that its decision to approve states' Medicaid work requirement waivers can withstand any litigation challenging the policy shift. Hours after the guidance's release, Families USA announced it was working closely with the National Health Law Program and others to support legal challenges against the new policy if the CMS actually approves these waivers. However, during a call with reporters Thursday, CMS Administrator Seema Verma said she believes that the law is on the agency's side. "The 1115 [statute] gives broad authority to the secretary to approve state experiments and programs that promote the objectives of the Medicaid program," Verma said. She added there are studies that show the benefits employment has on a person's health.
  
  
• In States That Didn't Expand Medicaid, Hospital Closures Have Spiked  Stat by Casey Ross — In recent years Obamacare’s Medicaid expansion has created a financial fault line in American health care. Hospitals in states that enacted the expansion got a wave of newly insured patients, while those in states that rejected it were left with large numbers of uninsured individuals. A new study released Monday reports a crucial consequence of that divide: Nonexpansion states have suffered a significant increase in hospital closures. States that expanded benefits, on the other hand, saw their rate of closures decline.  The study, published in Health Affairs, is the first to clearly document the extent of that divergence across the country. 

• Trump’s Secret Plan to Scrap Obamacare  Politico by Jennifer Haberkorn — The document, revealed for the first time by POLITICO, shows that despite the chaos surrounding repeal, the administration had an elaborate plan to take apart the law using executive authority.  Early last year, as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health care law using executive authority. The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it. Top administration officials had always said they would eradicate the law through both legislative and executive actions, but they never provided the public with anything close to the detailed blueprint shared with the members of the House Freedom Caucus, whose confidence — and votes — President Donald Trump was trying to win at the time.
  
  
• 'Nothing Is Actually Being Done': Trump's Opioid Emergency Order Disappoints  Politico by Brianna Ehley — President Donald Trump in October promised to "liberate" Americans from the "scourge of addiction," officially declaring a 90-day public health emergency that would urgently mobilize the federal government to tackle the opioid epidemic. That declaration runs out on Jan. 23, and beyond drawing more attention to the crisis, virtually nothing of consequence has been done. Trump has not formally proposed any new resources or spending, typically the starting point for any emergency response. He promised to roll out a “really tough, really big, really great” advertising campaign to spread awareness about addiction, but that has yet to take shape. And key public health and drug posts in the administration remain vacant, so it’s not clear who has the authority to get new programs moving.
  
  
• Trump's HHS Pick Appears to Be on Track for Confirmation Politico by Adam Cancryn and Sarah Karlin-Smith — President Donald Trump’s nominee to run the Department of Health and Human Services (HHS) appears on the brink of confirmation, which will usher in a new era of Republican efforts to remake major health care programs after legislative stumbles last year. The expected confirmation of Alex Azar, who appeared before a Senate panel Tuesday, would put the conservative policy expert in charge of rewriting the rules of the U.S. health care system with a broad mandate to use the powers to the fullest. And following a tumultuous year marked by failed Obamacare repeal efforts and the abrupt resignation of Trump’s first HHS secretary, Republicans think Azar can ably get the Trump administration’s health agenda on track.
  
  
• Trump Officials, After Rejecting Obama Medicare Model, Adopt One Like It New York Times by Robert Pear — In a notable back flip, the Trump administration has decided that maybe the Obama administration was right in its efforts to change the way doctors and hospitals are paid under Medicare. The Trump administration said late Tuesday that it was starting a Medicare payment model very similar to the ones it canceled and curtailed last year. The Obama administration devised the earlier projects using authority in the Affordable Care Act. In the new program, as described by Trump appointees, Medicare will make a single "bundled payment" for nearly all the services provided in a 90-day period to certain Medicare patients who are admitted to a hospital or have certain outpatient medical procedures. … "The current administration would like to reverse everything associated with the Affordable Care Act and the Obama administration," Dr. Fisher said. "But this week’s announcement shows that there is a bipartisan consensus on the need to change the way we deliver and pay for health care."
  
  
• Republicans Scale Down Agenda for Safety-Net Programs, Health Law The Wall Street Journal by Kristina Peterson and Stephanie Armour — Republicans are scaling back their ambitions to overhaul safety-net programs and dismantle the Affordable Care Act following President Donald Trump’s weekend retreat with GOP leaders, due to concerns they can’t muster enough support ahead of the 2018 midterm elections. Instead, Republican lawmakers are likely to embrace a slimmed-down agenda focused on the basics, including funding the government, raising the government debt limit, and striking a deal on immigration, according to GOP lawmakers and aides.

• Individual Mandate Now Gone, G.O.P. Targets the One for Employers  New York Times by Robert Pear - Having wiped out the requirement for people to have health insurance, Republicans in Congress are taking aim at a new target: the mandate in the Affordable Care Act that employers offer coverage to employees. And many employers are cheering the effort. While large companies have long offered health benefits, many have chafed at the detailed requirements under the health law, including its reporting rules, which they see as onerous and expensive. Now that relief has been extended to individuals, some companies believe they should be next in line.

Editor: Peter Van Vranken